Lee Yujin, Park Inseok, Cho Hyunjin, Gwak Geumhee, Yang Keunho, Bae Byung-Noe
Department of General Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Ann Coloproctol. 2021 Oct;37(5):298-305. doi: 10.3393/ac.2020.00829.0118. Epub 2021 Jul 6.
Adjuvant chemotherapy (AC) is recommended for patients with stage II colorectal cancer with adverse features. However, the effect of adjuvant treatment in elderly patients with high-risk stage II colorectal cancer remains controversial. This study aimed to investigate the oncologic outcomes in elderly high-risk stage II colorectal cancer patients who underwent curative resection with or without AC.
Patients aged over 70 years having stage II colorectal adenocarcinoma with at least 1 adverse feature who underwent radical surgery between 2008 and 2017 at a single center were included. We compared recurrence-free survival (RFS) and overall survival (OS) between patients who received more than 80% of the planned AC cycle (the AC+ group) and those who did not receive it (the AC- group).
The AC+ and AC- group contained 46 patients and 50 patients, respectively. The log-rank test revealed no significant intergroup differences in RFS (P=0.083) and OS (P=0.122). In the subgroup of 27 patients with more than 2 adverse features, the AC+ group (n=16) showed better RFS (P=0.006) and OS (P=0.025) than the AC- group. In this subgroup, AC was the only significant factor affecting RFS in the multivariate analysis (P=0.023). AC was significantly associated with OS (P=0.033) in the univariate analysis, but not in the multivariate analysis (P=0.332).
Among elderly patients with stage II high-risk colorectal cancer, the AC+ group did not show better RFS or OS than the AC- group. However, selected patients with more than 2 adverse features might benefit from AC.
对于具有不良特征的II期结直肠癌患者，推荐进行辅助化疗（AC）。然而，辅助治疗对老年高危II期结直肠癌患者的疗效仍存在争议。本研究旨在调查接受或未接受AC的根治性切除的老年高危II期结直肠癌患者的肿瘤学结局。
纳入2008年至2017年在单中心接受根治性手术的70岁以上患有II期结直肠腺癌且至少有1个不良特征的患者。我们比较了接受超过80%计划AC周期的患者（AC+组）和未接受AC的患者（AC-组）之间的无复发生存期（RFS）和总生存期（OS）。
AC+组和AC-组分别包含46例和50例患者。对数秩检验显示，两组在RFS（P=0.083）和OS（P=0.122）方面无显著组间差异。在具有2个以上不良特征的27例患者亚组中，AC+组（n=16）的RFS（P=0.006）和OS（P=0.025）均优于AC-组。在该亚组中，多变量分析显示AC是影响RFS的唯一显著因素（P=0.023）。单变量分析中AC与OS显著相关（P=0.033），但多变量分析中并非如此（P=0.332）。
在老年II期高危结直肠癌患者中，AC+组的RFS或OS并不优于AC-组。然而，选择的具有2个以上不良特征的患者可能从AC中获益。
